Table of Contents
FORM GST APL – 03
[See rule 109(1)]
Application to the Appellate Authority under sub-section (2) of Section 107
- Name and designation of the appellant Name-
- Designation-
- Jurisdiction-
- State/Center-
- Name of the State-
- GSTIN/ Temporary ID /UIN-
- Order no. Date-
- Designation and address of the officer passing the order appealed against-
- Date of communication of the order appealed against-
- Details of the case under dispute-
- Brief issue of the case under dispute-
- Description and classification of goods/ services in dispute-
- Period of dispute-
- Amount under dispute-
| Description | Central tax | State/ UT tax | Integrated tax | Cess |
| a) Tax/ Cess | ||||
| b) Interest | ||||
| c) Penalty | ||||
| d) Fees | ||||
| e) Other charges |
- Statement of facts-
- Grounds of appeal-
- Prayer-
- Amount of demand in dispute, if any –
| Particulars of demand/refund , if any | Particulars | Centra l tax | State/UT tax | Integrated tax | Cess | Total amount | ||
| Amount of demand created, | a) Tax/ Cess | < total | < total | |||||
| if any (A) | > | > | ||||||
| b) Interest | < total > | |||||||
| c) Penalty | < total > | |||||||
| d) Fees | < total > | |||||||
| e) Other charges | < total > | |||||||
| Amount under dispute (B) | a) Tax/ Cess | < total > | < total > | |||||
| b) Interest | < total > | |||||||
| c) Penalty | < total > | |||||||
| d) Fees | < total > | |||||||
| e) Other charges | < total > |
Place:
Date:
Signature
Name of the Applicant Officer:
Designation:
Jurisdiction:
Official Income Tax Return filing website: https://incometaxindia.gov.in/
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